ATHENS   7 - 12  Mai 2018












When the solution of complex situations seems impossible:   how to listen  for a deepest  understanding ?   
When the body speaks through his silence and his wounds:   
who will listen and hear before intervening?



Patricia O.  born 10/11/1986. Nigeria


1. History

Patricia is a young pregnant woman, living in a residence for migrant mothers, run by the Town Hall of Rome. We meet her after a psychomotor crisis during which she assaulted a woman, hosted in the same place and we therefore activated a compulsory treatment in the psychiatric ward of S. Filippo Neri Hospital.

Patricia is not aware of being seven months pregnant and after a month in the  psychiatric department she is transferred to the gynecology department to deliver.

Due to her mental confusion and severe relationship difficulties, a nurse is constantly with her to prevent runaways or assaults to other patients.

From now on our integrated group focused on homeless with mental problems, is involved in Patricia’s care process.  Through the hospital's social worker and other operators of our group, we try to retrace Patricia’s story.

Patricia is totally absorbed in her delirium of pregnancy denial and when questioned about her story, she only answers  that she has been in Crotone where she has a home and a partner.

In some occasions she also provides some phone numbers but all the attempts to call those failed.

At the end of December 2016 Patricia gives birth to a child, but, continuing the state of delusional denial, 10 days after birth, the adoption process is activated.

As far as we understand, she certainly landed in Lampedusa, where she lived for about a month and was moved to a refugees’ camp in Crotone. In our last meeting in a cliinic where she is currently sheltered, for the very first time she speaks about her husband, who is maybe in prison, not  even recalling his name.

During her staying  in Crotone, most likely Patricia entered in prostitution and became pregnant; it seems like that only through this condition she was able to seek help from the institutions


2. Health

Patricia’s physical health condition seems to be satisfying, but her psychic state is very disturbed and a first diagnosis of puerperal psychosis (ICD 10: F 53.1) remains unchanged, even after childbirth.

A sharp relational retreat is evident and contacts are only established through continuous requests for concrete items. Patricia sometimes steals small things, often  for female use, and above all, she is constantly asking for money; in some cases she is available for sex, for a few cents or some coffee.

The clinical course of psychosis tends to improve in the first months after childbirth.

However, considering she has succeeded in the difficult migratory journey  and with reference to to the psychopathological characteristics of the current clinical picture, all symptoms can be referred to a “post traumatic stress disorder” [309.81] rather than to the schizophrenia spectrum


3. Intervention

The Integrated Group operating at the Public Mental Health Center of Via A. Di Giorgio of ASL Roma/ 1, sets up a small team to work around this case. At first we meet Patricia in the gynecologic ward of the Hospital, then in the psychiatric department.

Soon the hospital social worker  tries to find out any detail about Patricia’s relatives or friends, in Italy or in her country, visiting the embassy and the Nigerian community in Rome and in the refugee’s camp in Crotone, without success.

After a first phase of adaptation in the hospital, Patricia is moved to the Villa Maria Pia clinic, linked with our group. Here psychopharmaceuticals on high doses are administered and Patricia reacts improving her behaviour and her mental condition.

In collaboration with the Social Worker Room (SOS) of Rome, she is therefore transferred to a residence for migrants; a few days later she assaults a guest trying to steal her necklace. Once again she’s hospitalized to St. Filippo's psychiatric ward, where her mood is excited and she looks very delusional: it was shocking to find a died little bird in her purse, maybe related to her denied pregnancy.

From here, another attempt to investigate her identity through police’s record and fingerprints failes, because Patricia unpredictably,  runs away from the police station.

When two weeks later, the outreach team of the Social Worker Room detects her, back in the street, she agrees to go back to the Clinic .

Nowadays and since several months, thanks to a recovery extention, Patricia is living in a Psychiatric Clinic, Villa Letizia, devoted to chronic schizophrenic patients. 

Unfortunely, whilst persisting the dissociative disorder, she still has no memory at all and for us is impossible to reconnect her with any contacts in her country or in ours.

Next step in our project is to appoint a support administrator, to care for her rights and future in our country.


4. Operators and Network

 Since the begining the collaboration between hospital departments, social services of the Municipality of Rome and our group, dealing with homeless with mental desease, has been very intense and effective.

In Italy in these cases a network between institutions and services is not set up and the autonomy and the "missions" of each service prevents the possibility of coordinated interventions, with a great waste of energy and money and  a big frustration of the involved operators.

As already experienced in other cases handled by this group over the years, a cooperation substained by a network is effective in terms of results and does not require any additional economic resources than those provided for each service.


5. Possible proposals

Our team, even in this  difficult case, managed to get in touch and collaborate with the various institutions which should care, although facing a lack of financial funds for daily expenses and clothing.

It is serious not to have any cooperation with Embassies of the country of origin, neither a specific reference perhaps at the Interior Ministry or at the police station, in order to achieve informations concerning the identity and the paths that these subjects may have had since arriving in Italy  (contact points in Lampedusa, Crotone or info about  the people who may have accompanied Patricia on her Italian permanence).

In such case we must have an easy and fast access to personal information through fingerprints , previous ID control, mug shots, supported by police cooperation


ERASMUS +    ANNEX II - KA2     Ag. Nb.:  2016-1-PT01-KA202-022970

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